Frequent Mental Distress in United States

United States

A healthy mental state is essential to overall positive health and well-being. In some cases, poor mental health may lead to suicide. Frequent mental distress aims to capture the population experiencing persistent, and likely severe, mental health issues, defined by 14 or more days of self-reported poor mental health in the past month. Frequent mental distress is associated with smoking, physical inactivity, housing insecurity, food insecurity and insufficient sleep. 

Direct medical spending associated with mental health disorders (including anxiety, depression and dementia) in the United States reached $201 billion in 2013, surpassing costs for heart disease ($147 billion) and traumatic injury ($143 billion).

According to America’s Health Rankings data, the prevalence of frequent mental distress is higher among:

• Women compared with men.
• Adults ages 18-44 compared with those ages 45 and older.
• Multiracial, American Indian/Alaska Native and Hawaiian/Pacific Islander adults compared with white and Asian adults.
• Adults with less than a high school education compared with college graduates.
• Adults with an annual household income of $25,000 or less compared with those with higher income levels.
• Adults who have difficulty with cognition compared with adults without a disability.
• LGBQ+ adults compared with straight adults.
• Adults who have not served compared with adults who have served in the U.S. armed forces. 

Additionally, one study found that the prevalence of frequent mental distress was higher among adults without health insurance, adults who are unemployed or unable to work and adults who are divorced, widowed or separated.

Although occasional short periods of mental distress may be unavoidable, more prolonged and serious episodes are treatable and may be prevented through early interventions.

The Community Guide lists several strategies that are effective at improving mental health, including:

• School-based cognitive behavioral therapy. 
• Home-based depression care management. 
• Collaborative care.

The RAND Corporation has recommendations to transform the mental health system centered around three main goals: promoting pathways to care, improving access to care and establishing a continuum of evidence-based care.

Continued monitoring of frequent mental distress trends may help identify unmet social and mental health needs and inform future interventions. The Centers for Disease Control and Prevention has a resources page for mental health, including a mental health services locator. The 988 Suicide & Crisis Lifeline provides free, confidential support for people in distress 24/7 anywhere in the United States.

Healthy People 2030 has numerous objectives related to mental health, including: 

• Increasing the proportion of primary care visits where adolescents and adults are screened for depression. 
• Increasing the proportion of adults with serious mental illness who get treatment.

Arango, Celso, Covadonga M. Díaz-Caneja, Patrick D. McGorry, Judith Rapoport, Iris E. Sommer, Jacob A. Vorstman, David McDaid, et al. “Preventive Strategies for Mental Health.” The Lancet Psychiatry 5, no. 7 (July 2018): 591–604. https://doi.org/10.1016/S2215-0366(18)30057-9.

Bruning, John, Ahmed A. Arif, and James E. Rohrer. “Medical Cost and Frequent Mental Distress among the Non-Elderly US Adult Population.” Journal of Public Health 36, no. 1 (March 1, 2014): 134–39. https://doi.org/10.1093/pubmed/fdt029.

Liu, Yong, Rashid Njai, and Kurt J. Greenlund. “Relationships Between Housing and Food Insecurity, Frequent Mental Distress, and Insufficient Sleep Among Adults in 12 US States, 2009.” Preventing Chronic Disease 11 (March 13, 2014). https://doi.org/10.5888/pcd11.130334.

McBain, Ryan K., Nicole K. Eberhart, Joshua Breslau, Lori Frank, M. Audrey Burnam, Vishnupriya Kareddy, and Molly M. Simmons. “Transforming Mental Health Care in the United States.” RAND Corporation, 2021. https://doi.org/10.7249/RBA889-1.

Moriarty, David G., Matthew M. Zack, James B. Holt, Daniel P. Chapman, and Marc A. Safran. “Geographic Patterns of Frequent Mental Distress: U.S. Adults, 1993–2001 and 2003–2006.” American Journal of Preventive Medicine 36, no. 6 (June 1, 2009): 497–505. https://doi.org/10.1016/j.amepre.2009.01.038.

Roehrig, Charles. “Mental Disorders Top The List Of The Most Costly Conditions In The United States: $201 Billion.” Health Affairs 35, no. 6 (June 1, 2016): 1130–35. https://doi.org/10.1377/hlthaff.2015.1659.